A surgical team from Johns Hopkins Hospital in Baltimore performed a total penis and scrotum transplant, the first operation of its kind anywhere in the world.
The Johns Hopkins surgical team at work on the patient. Photo: Johns Hopkins Hospital
The 14-hour procedure, called a vascularised composite allotransplantation, was carried out by two urological surgeons and nine plastic surgeons on 26 March 2018. Incredibly, the transplant involved a single piece of tissue that weighed around 2.25kg and measured about 25cm across.
A deceased donor provided the entire penis, scrotum (without testicles) and partial abdominal wall. Surgeons worked to transplant the skin, muscles, tendons, nerves, bone and blood vessels. The surgery appears to have been a success, but like any transplant, the physicians are now watching carefully to make sure the patient's body doesn't reject the new tissue.
The recipient, who wishes to remain anonymous, had his genitals destroyed by a bomb while serving in Afghanistan. The serviceman also lost both legs below his knees, but he was particularly distraught by the loss of his genitals.
"That injury, I felt like it banished me from a relationship," he told The New York Times. "Like, that's it, you're done, you're by yourself for the rest of your life. I struggled with even viewing myself as a man for a long time." Since the surgery, he said, "I feel whole again." The patient is quickly recovering, and is expected to go home later this week.
Diagram of the procedure. Illustration: Johns Hopkins Hospital
This latest penis transplant is the third to be performed, but unlike the other two - the first in South Africa in 2014 and the second at Massachusetts General Hospital in 2016 - this transplant involved the scrotum and surrounding tissue in addition to the penis. It's also the first penis transplant performed on a combat veteran injured by an explosive device.
In a statement, W.P. Andrew Lee, director of plastic and reconstructive surgery at the Johns Hopkins University School of Medicine, said he's "hopeful the transplant will restore near-normal urinary and sexual functions for this young man". In addition to being able to pee with the new penis, the patient should eventually be able to produce a spontaneous erection and achieve orgasm. He is currently taking testosterone, and will use the drug Cialis to promote erectile function following sufficient healing and nerve regeneration.
The donor's testes weren't transplanted for ethical reasons; the doctors thought it might be possible for the recipient to father children who would be genetically related to the donor, something not allowed by medical guidelines.
During the wars in Iraq and Afghanistan, around 1300 US servicemen sustained "genitourinary" injuries, of which 31 per cent involved injuries to the penis, according to the US Department of Defence. It's still early days, but this latest medical breakthrough finally offers some hope.